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. 2020 Nov 2;6(1):56-65.
doi: 10.1016/j.ekir.2020.10.020. eCollection 2021 Jan.

A Systematic Review of the Incidence of Arrhythmias in Hemodialysis Patients Undergoing Long-Term Monitoring With Implantable Loop Recorders

Paul R Roberts  1 , Kurt Stromberg  2 , Lawrence C Johnson  2 , Benedict M Wiles  1 , Thomas A Mavrakanas  3 , David M Charytan  4
Affiliations

A Systematic Review of the Incidence of Arrhythmias in Hemodialysis Patients Undergoing Long-Term Monitoring With Implantable Loop Recorders

Paul R Roberts et al. Kidney Int Rep. .

Abstract

Introduction: Establishing the frequency and nature of arrhythmias in hemodialysis (HD) is an important step in improving outcomes of these patients. We undertook this systematic review and meta-analysis to characterize arrhythmia frequency in maintenance HD patients.

Methods: We identified studies on arrhythmias in adult patients on maintenance HD detected via implantable loop recorders (ILRs). Studies included were in English and reported ILR-detected arrhythmia incidence in HD patients. Data were extracted by one author using electronic spreadsheets and verified by a second author. Random effects models were used for pooled inferences. The I 2 statistic was used to quantify heterogeneity.

Results: Five studies qualified for inclusion (317 patients). The overall estimates for the annualized rate of death and sudden cardiac death (SCD) was 0.14 (95% confidence interval [CI]: 0.11-0.18) and 0.06 (95% CI: 0.03-0.10), respectively. Across all 5 studies, the combined annualized rate of patients experiencing at least 1 bradycardia/asystole event was 0.19 (95% CI: 0.11-0.33) but heterogeneity was high (I 2 = 79.8%). The average annualized rate of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) episodes (0.02, 95% CI: 0.01-0.05) was significantly lower (P < 0.001) than the rate of bradycardia/asystole reported in the same patients. Incidence of atrial fibrillation (AF) varied significantly across the studies (from 0.07 to 0.83 patients per year) reflecting variable definitions (new-onset vs. total number of episodes).

Conclusion: The incidence of arrhythmias among chronic HD patients is high, with bradycardia/asystole occurring more frequently than ventricular arrhythmias. Additional studies to refine estimates particularly of AF are needed.

Keywords: asystole; bradycardia; hemodialysis; implantable loop recorder; sudden cardiac death.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Publication selection.
Figure 2
Figure 2
Annualized death rate for any cause pooled across studies. Vertical line indicates pooled estimate across studies. FUP, follow-up.
Figure 3
Figure 3
Annualized sudden cardiac death rate pooled across studies. Vertical line indicates pooled estimate across studies. FUP, follow-up; SCD, sudden cardiac death.
Figure 4
Figure 4
Annualized rate of arrhythmias by arrhythmia type pooled across studies. Vertical line indicates pooled estimate across studies. FUP, follow-up; VF, ventricular fibrillation; VT, ventricular tachycardia.
Figure 5
Figure 5
Annualized rate of atrial fibrillation (AF) pooled across studies by arrhythmia type pooled across studies. Top panel: new-onset AF. Bottom panel: new or recurrent any AF identified by implantable loop recorder (ILR). The study by Roberts et al. provided data only for new-onset AF. The study by Silva et al. provided data only for all ILR-detected AF and did not clearly distinguish between de novo and recurrent AF. FUP, follow-up.
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References

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